Massive Rotator Cuff Tears: Tips and Tricks for Surgical Management

Elsevier

Available online 12 January 2023, 150982

Operative Techniques in Sports MedicineAuthor links open overlay panelAbstract

Massive rotator cuff tears provide a significant challenge to the orthopedic surgeon. A complete and anatomic tendon restoration without significant tension is the goal of treatment, but oftentimes the chronicity of the presentation makes it difficult. The treating surgeon must approach these cases in a methodical and organized manner. Visualization and recognition of the tear pattern, followed by appropriate soft tissue releases, and finally thoughtful suture management are the keys to optimize surgical success and ultimately clinical outcomes. When the tendon cannot be anatomically restored to the native footprint, alternative options can be used with varying success. These alternatives include medialization of the footprint, partial repair, margin convergence, patch augmentation, among others. We will provide some tips and tricks which we have found most useful to successfully complete these often-difficult cases. For tears that cannot be repaired or if repair would be contraindicated or ill-advised, other options such as superior capsular reconstruction, tendon transfers, and reverse total shoulder arthroplasty are considerations that are beyond the scope of this manuscript.

Keywords

massive rotator cuff tear

shoulder arthroscopy

rotator cuff repair

tips

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